Provider Demographics
NPI:1083876437
Name:PESCE, JENNIFER M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:PESCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1919 W SWANN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2417
Mailing Address - Country:US
Mailing Address - Phone:813-254-7079
Mailing Address - Fax:316-253-1029
Practice Address - Street 1:1919 W SWANN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2404
Practice Address - Country:US
Practice Address - Phone:813-254-7079
Practice Address - Fax:813-443-8164
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME111034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0044912-00Medicaid